ORCID Profile
0000-0002-9611-3258
Current Organisations
University of Western Australia
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UNSW
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Publisher: Wiley
Date: 10-1992
DOI: 10.3109/00016349209041445
Abstract: Two rapid exercise pad tests, the vitamin B test, and the methylene blue test, are introduced for the diagnosis of urinary stress incontinence. The vitamin B test is entirely non-invasive, takes only a few minutes to perform, and is especially useful as an office test. The methylene blue test has fewer variables, and fits easily into a urodynamic routine. With the methylene blue test, a direct correlation was noted between amount of urine lost and pressure generated by the tests. This conforms to the definition of stress incontinence as a passive process. The sensitivity of the test in a group with mainly mixed symptoms was 89.5%, and the specificity 100%. The test is useful where objective diagnosis of stress incontinence is important. A group of 38 patients with a history (questionnaire) of stress incontinence exhibited a total of 105 positive in idual symptoms out of a possible 228 symptoms (6 x 38), comprising a history of leaking at sneezing, coughing, exercise, laughing, walking, or bending. The in idual symptoms were analyzed for accuracy and predictability by comparing them with six graded provocative exercises comprising a tr oline test, star jumps, coughing, stepping, bending and hand washing. The symptoms were graded into a hierarchy from the results. A history of stress incontinence was found to be an accurate determinant of stress incontinence, even in patients with mixed symptoms. This allows the questionnaire as presented to be used as a semiquantitative index for assessment purposes.
Publisher: Springer Science and Business Media LLC
Date: 16-02-2013
DOI: 10.1007/S10151-013-0980-4
Abstract: We describe our technique of low rectocele repair which is based on the approximation and lifting of the laterally displaced perineal bodies (PBs) using the Tissue Fixation System, a 7-mm-wide tensioned macropore polypropylene sling. In low rectocele, the PB between the rectum and vagina is thinned and laterally displaced but still attached to the deep transverse perineal (DTP) muscle. Our technique is described with the aid of a video. The vagina and rectum are dissected off the laterally displaced PBs. The DTP attachment of each PB to the descending ramus is identified per rectum. A tunnel is created in the DTP on both sides to insert the polypropylene mesh attached to an anchor. The loop of tape between the anchors is shortened via the one-way system at the base of the anchor to elevate the inferolaterally displaced PBs to a more medial position. This is infiltrated by collagen over time, creating a "neo-central tendon." The musculofascial layer of the rectum, the vagina, and superficial layers of the PBs are approximated. Our cure rate for low rectocele repair was in excess of 90 %, even with an early version of this procedure. Our method differs from rectocele repair with large mesh in that it precisely mimics the damaged structure and uses only very short thin strips of tape to approximate and reinforce PBs weakened by birth injury and age.
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.MEDENGPHY.2006.03.011
Abstract: A prototype compression elastometer suited to the characterisation of soft tissue is analysed and tested by application to various elastomers. The test material is pinched between two rigid cylinders and the compression force and displacement interpreted to yield a measure of "effective" stiffness or to calibrate a simple non-linear-elastic material model (Neo-Hookean). This deformation suits the testing of bulk soft tissue since it effectively isolates the test material from boundary conditions such as other soft tissue, ligaments and bones. These can be highly variable in the body and can affect results greatly when employing other types of tests to determine the elastic nature of tissue. A simple linear-material analysis, based on established solutions to two-dimensional problems, is extended to take into account various geometrical complexities. This analysis permits immediate inversion of the readings from the device to yield the elastic properties of the material, without the need for complex numerical analysis. Finite element analysis is also employed to determine the range of reliable application of the linear-elastic model. In particular, this analysis permits the extension of the linear-elastic analysis to include simple forms of non-linear-material behaviour. The method is demonstrated using three elastomers having significantly different material properties. A viable range of application of the device is identified in which it yields results with reasonable precision and accuracy. The prototype device was able to measure the effective elastic modulus of the test materials with a maximum error of 13% for three material types (N=25). Repeatability error was less than 7% in all cases. Further refinement of the device and measuring system will reduce this uncertainty.
Publisher: Wiley
Date: 10-1992
DOI: 10.3109/00016349209041446
Abstract: The reliability of urge symptoms associated with actual observed urine loss was tested using subtracted cystometry, and a hand-washing pad test in a total of 169 patients with urinary incontinence, 70 of whom had a prior history of urge incontinence. Our results showed: 1. that urodynamic or pad tests performed at a single point in time cannot retrospectively confirm a patient's past history of urge incontinence with any reliability 2. a patient's history of urge incontinence is likely to be accurate.
Publisher: Springer Science and Business Media LLC
Date: 19-10-2014
DOI: 10.1007/S00345-014-1419-X
Abstract: Existing theories for micturition in the female mandate total relaxation of the pelvic floor while detrusor pressure pushes the urethra open. However, video X-ray and electromyogram data indicate that micturition is preceded by active outwards opening of the outflow tract by backward-/downward-acting muscle vectors. If the detrusor pressure alone is enough to expand the tube, why does the active opening take place? The aim was to model the urethral tube in detail to assess the relative importance of the active opening mechanism and detrusor pressure. Finite element methods were used to model the urethral tube in detail. Nonlinear-elastic properties similar to urethral component tissues were taken from the literature. The boundary conditions applied to the tube model included internal pressure due to detrusor contraction (60 cm H2O) and various displacements and constraints such as pubourethral and pubovesical ligament attachments. In order to achieve opening dimensions similar to those in the lateral X-ray under the action of detrusor pressure alone, the pressure had to be increased by two orders of magnitude above normal levels. Normal detrusor pressure alone is not sufficient to achieve opening of the urethra against the elasticity of the constituent tissues, suggesting that normal micturition requires an active mechanism provided by backward-/downward-acting pelvic floor muscles, as predicted by the integral theory.
Publisher: Elsevier BV
Date: 06-2018
Publisher: Springer Milan
Date: 2010
Publisher: Elsevier BV
Date: 10-2000
Publisher: Elsevier BV
Date: 09-1999
DOI: 10.1016/S0140-6736(99)03069-X
Abstract: Dynamic perineal ultrasound studies show that midurethral anchoring of vagina prevents bladder neck descent, funnelling, and urine loss on effort. Appearances are consistent with continence control by a musculoelastic mechanism.
Publisher: Wiley
Date: 1999
DOI: 10.1002/(SICI)1520-6777(1999)18:2<81::AID-NAU3>3.0.CO;2-Z
Abstract: Detrusor instability is a major cause of urinary incontinence in females. Its cause is unknown. Diagnosis is made with cystometry. A phasic pressure rise during cystometry diagnoses the unstable detrusor, and a non-phasic pressure rise the stable "low-compliance" detrusor. The aim was to test the hypothesis that such cystometric findings may represent different levels of disturbance in peripheral feedback control of a prematurely activated, but otherwise normal micturition reflex. Of 169 neurologically normal female incontinent patients (mean age, 50 mean parity, 3) urodynamically tested, 40 had detrusor instability and 16 had low compliance. Digital support of bladder base tested the peripheral control mechanism, and hand-washing the central control mechanism. The data were applied to a non-linear feedback equation with one variable, X(NEXT) = cX(1 - X), where c = central inhibition and X = fraction of possible nerve impulses in the micturition circuit. During filling, all 16 low-compliance patients had a bladder in the activated but stable closed state. Fourteen of the detrusor instability group could not suppress the micturition reflex and lost urine. During hand-washing, unexpectedly greater urine loss was noted in the low-compliance group (13 of 16) than in the detrusor instability group (24 of 40), chi2 (P < 0.005). With digital stretching, urge symptoms disappeared within a few seconds in 18/20 patients, and detrusor instability was suppressed in six patients. The bladder has two stable states: open and closed. Closure is regulated by central and peripheral components. In the female, the peripheral component is controlled by the pelvic floor stretching the vagina to support the urine column. This prevents inappropriate activation of the micturition stretch receptors. In patients with low compliance, this peripheral control mechanism was sufficient to maintain the micturition reflex in an activated but stable closed state. In patients with detrusor instability, the micturition reflex could not be suppressed, swinging between the open and closed states. Demonstration of a peripheral musculoelastic control mechanism unlocks a new direction for management of female patients with non-neurological bladder instability. It is possible, using simple clinical methods based on digital vaginal stretching, to predict cure of instability by surgical tightening of the vagina and its supporting ligaments.
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08034.X
Abstract: Abstract Urinary incontinence was observed in 19 patients after bladder neck elevation or vaginal repair operations. Characteristically, patients could not suppress their urge to micturate on getting up in the morning, and they wet before arrival at the toilet. Urodynamically, a high posterior cough transmission ratio was noted. A 1.5 cm longitudinal incision in the vagina, dissected free and resutured horizontally (I‐plasty), immediately cured this particular condition, but ultimately failed in 1/3 cases. Most of these failed patients were subsequently cured by further adjustment of vaginal tension under local anaesthesia (Tuck procedure). These findings confirm the emphasis given by the Integral Theory of Female Urinary Incontinence as to maintain adequate elasticity in the zone of critical elasticity (ZCE) of the supralevator vagina. The ZCE acts as an elastic hinge, allowing (i.e. facilitates) the separate and opposite contractile forces of anterior pubococcygeus, and levator plate which are necesary to close off urethra and bladder neck respectively. Inadequate elasticity at the ZCE converts the ZCE's role from facilitation to opposition. The stronger levator muscle contraction counteracts the forward action of the weaker anterior part of pubococcygeus muscle, preventing bladder neck closure.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2022
DOI: 10.1007/S00345-022-03938-Z
Abstract: In 45 years, the definitions and practice of the urodynamically based overactive bladder (OAB)/detrusor overactivity (DO) system have failed to adequately address pathogenesis and cure of urinary urge incontinence, frequency and nocturia. We analysed the OAB syndrome with reference to the Integral Theory paradigm's (ITS) binary feedback system, where OAB in the female is viewed as a prematurely activated, but otherwise normal micturition caused mainly, but not entirely, by ligament damage/laxity. The ITS Clinical Assessment Pathway which details the relationships between structural damage (prolapse), ligaments and dysfunction (symptoms) is introduced. The ITS was able to "better explain" OAB pathophysiology in anatomical terms with reference to the binary model. The phasic patterns diagnostic of "detrusor overactivity" are explained as a struggle for control by the closure and micturition reflexes. The exponentially determined relationship between urethral diameter and flow explains why obstructive patterns occur, why they do not and why urine may leak with no recorded pressure. Mechanically supporting ligaments ("simulated operations") during urodynamic testing can improve low urethral pressure, negative pressure during coughing with SUI and diminish urge sensation or even DO patterns, transforming urodynamics from non-predictive test to accurate predictor of continence surgery results. High cure rates for OAB by daycare repair of damaged ligaments is a definitive test of the binary system's validity. Conceptual progression of OAB to the Integral Theory paradigms's prematurely activated micturition validates OAB component symptoms as a syndrome, explains pathogenesis, and unlocks a new way of understanding, diagnosing, treating and researching OAB.
Publisher: Springer Science and Business Media LLC
Date: 02-2022
Publisher: Wiley
Date: 04-2012
Publisher: Springer Science and Business Media LLC
Date: 04-2004
DOI: 10.1007/S00192-004-1122-3
Abstract: The normal pelvic floor functions as a balanced synergistic system composed of muscle, connective tissue (CT), and nerve components, with CT being the most vulnerable. The aim was to address a wide range of pelvic floor dysfunctions by strengthening all possible components of the system with minimal time loss, weaving every element of treatment seamlessly into a daily routine. The study group consisted of patients from a tertiary referral pelvic floor clinic who, after testing, opted for nonsurgical treatment of their problem. There were no exclusion criteria. The patients had presented with symptoms which included stress, urge, frequency, nocturia, abnormal emptying and pelvic pain, and the fate of these was tracked prospectively. The regime comprised four visits in 3 months. An anatomical classification guided diagnosis of anatomical defects in the anterior, middle and posterior compartments of the vagina. HRT was administered to all patients, electrotherapy 20 min per day for 4 weeks, squeezing 3 x 12 per day, reverse pushdowns 3 x 12 per day and squatting or equivalent up to 20 min per day. Of 147 patients (mean age 52.5 years), 53% completed the programme. Median QOL improvement reported was 66%, mean cough stress test urine loss reduced from 2.2 g (range 0-20.3 g) to 0.2 g (range 0-1.4 g), p =<0.005, and 24-h pad loss from a mean of 3.7 g (range 0-21.8 g) to a mean of 0.76 g (range 0-9.3 m), p =<0.005. Frequency, nocturia and pelvic pain were significantly improved ( p=<0.005). Residual urine reduced from mean 202 ml to mean 71 ml ( p=<0.005). This method extends indications for nonsurgical therapy beyond stress incontinence, and the results appear to encourage this approach. Confirmation by other investigators is required.
Publisher: Digital Science Press (Urotoday International Journal)
Date: 2009
Publisher: Elsevier BV
Date: 2020
Publisher: Wiley
Date: 15-01-2019
DOI: 10.1002/NAU.23917
Abstract: The terminology for nocturia and nocturnal lower urinary tract function is reviewed and updated in a clinically and practically-based consensus report. This report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardisation Steering Committee (SSC). All relevant definitions were updated on the basis of research over the last 16 years since the publication of the first nocturia standardization document in 2002. An extensive process of 16 rounds of internal and external reviews was involved to examine each definition exhaustively, with decision-making by collective opinion (consensus). A clinically-based terminology report for nocturia and nocturnal lower urinary tract function, encompassing five key definitions ided into signs and symptoms has been developed. Clarity and user-friendliness have been key aims to make it interpretable by healthcare professionals and allied healthcare practitioners involved in the care of in iduals with nocturnal lower urinary tract function. A consensus-based terminology report for nocturia and nocturnal lower urinary tract function has been produced to aid clinical practice and research.
Publisher: Wiley
Date: 08-06-2015
DOI: 10.1111/AOGS.12677
Publisher: Elsevier BV
Date: 03-1994
Publisher: Wiley
Date: 04-2016
DOI: 10.1111/CODI.13119
Abstract: The perineal body (PB) plays an important role in supporting the pelvic floor and the posterior vaginal wall, but its attachments and relationships are still debated. This study aimed to assess the normal anatomy of the PB using high-resolution three-dimensional endovaginal ultrasound (3D-EVUS) in asymptomatic nulliparae. To validate the identification of perineal structures, 3D-EVUS was initially performed on nulliparous cadavers. Fresh frozen pelves were prepared and echogenic structures thought to be the PB, the external anal sphincter, the superficial and deep transverse perineii, pubovaginalis, puboperinealis, puboanalis, puborectalis and iliococcygeus muscles were tagged with biopsy needles, and marked with indigo carmine dye for localization during dissection. In the second part of the study, consecutive asymptomatic nulliparae were prospectively imaged with the same ultrasound modality. Interrater reproducibility was assessed off-line from stored 3D US volumes using a standardized technique. Five fresh frozen pelves and 44 asymptomatic nulliparae were assessed with 3D-EVUS. The PB was seen as an ovoid structure of mixed echogenicity between the rectum and vagina. It appeared to be ided into a superficial level, in contact with the external anal sphincter, the bulbospongiousus and the superficial transverse perineii muscle and a deep level, in contact with puboperinealis and puboanalis muscles. Interobserver repeatability was excellent for the measurements of PB height [intraclass correlation coefficient (ICC) 0.927], PB depth (ICC 0.969) and PB width (ICC 0.932). The PB is ided into two levels with different anatomical relationships with the pelvic floor muscles. 3D-EVUS yields reproducible assessment of this complex structure.
Publisher: Wiley
Date: 08-1996
DOI: 10.1111/J.1479-828X.1996.TB02727.X
Abstract: The aim was to prospectively study the relationship between pelvic pain of otherwise unknown origin and laxity in the posterior vaginal fornix. Twenty-eight patients with negative laparoscopy findings, lower abdominal pain and laxity in the posterior ligamentous supports of the uterus underwent surgical approximation of their uterosacral ligaments. At 3-month review, 85% of patients were cured, and at 12 months, 70%. Nonorganic pelvic pain has frequently been attributed to psychological factors. However, the results suggest that this may be a T12-L1 parasympathetic pain referred to the lower abdomen, perhaps due to the force of gravity stimulating pain nerves unable to be supported by the lax uterosacral ligaments in which they are contained. It was concluded that laxity in the posterior ligaments of the vagina should first be excluded before referring patients with pelvic floor discomfort or pain for psychiatric care.
Publisher: Springer Science and Business Media LLC
Date: 10-01-2008
DOI: 10.1007/S00192-007-0547-X
Abstract: We have previously reported preliminary (9 month) results using the tissue fixation system (TFS) in patients with stress incontinence. The aim of the study was to assess the effectiveness of the TFS in patients with genuine stress incontinence at 3 years. The TFS uses two small plastic anchors to fix a (adjustable) midurethral polypropylene mesh sling into the pelvic muscles and tissues below the retropubic space. Thirty-six patients with stress incontinence, mean age 55 (35-87), mean weight 76 kg, (33-117 kg), mean 0.8 previous operations for stress incontinence, underwent a TFS midurethral sling operation between 2003 and 2004. The suburethral vaginal fascia was also tightened. The patients were contacted by telephone independently by a nurse. The critical question was "Do you leak when you cough?" A negative answer was taken as a cure. If she said "sometimes", she was asked on a scale of 1 to 100 what her improvement was. Of the 31 patients contacted, total symptomatic cure was reported by 25 patients (80%) and > 70% cure in a further two patients (6.5%). Five patients could not be contacted. There was a slight deterioration in cure rate for stress incontinence between 9 months and 3 years, similar to that seen with retropubic midurethral sling surgery.
Publisher: Wiley
Date: 08-1999
DOI: 10.1111/J.1479-828X.1999.TB03414.X
Abstract: An assessment of the medium term efficacy of stress incontinence cure in a group of patients who had undergone the intravaginal slingplasty (IVS) operation is presented. Eighty-five unselected patients, aged 27 to 83 years at the time of surgery, 12 with pure stress symptoms, and 73 with mixed incontinence symptoms underwent the IVS procedure between 31 and 57 months previously (mean 3.9 years). The patients were assessed with the same self-administered semiquantitative questionnaire used in the initial assessment. The results were compared with the original cure rate which was 88% at 1.75 years with another 2.5% more than 70% improved (total 90.5%). The cure rate in the 75 patients assessed at 3.9 years was 81%, with another 8% reporting more than 70% improvement (total 89%). Included in the latter were 2 patients who, though originally designated as failures, gradually achieved almost 100% continence within 2 years of surgery. Deterioration of continence following the IVS operation appears more like the Burch colposuspension than needle suspensions. It is possible to explain deterioration of continence with time in terms of age-related connective tissue laxity of the vaginal hammock. Improvement in 2 women with time can be explained by tightening of the hammock via paraurethral scar contraction with time. Whether the IVS operation improves or deteriorates in the longer term may depend on which process predominates.
Publisher: Wiley
Date: 05-1992
Publisher: Elsevier
Date: 2008
Publisher: Informa Healthcare
Date: 04-12-2015
DOI: 10.1517/14712598.2016.1118459
Abstract: Controversy exists regarding the therapeutic benefit of cell-based therapy in the treatment of stress urinary incontinence (SUI). The aim of this systematic review was to evaluate evidence regarding the therapeutic effect and safety of cell-based therapy in the treatment of SUI and to propose a new approach to SUI treatment utilizing tissue engineering methodologies. We have thoroughly reviewed the literature using PubMed in order to identify only original, clinical studies involving cell therapy for SUI. Cell-based therapy, as practiced today, is a safe but ineffective method for SUI treatment. The key to an optimal therapeutic outcome in SUI is accurate diagnosis combined with targeted therapy. Targeted therapy in SUI should be based on cell implantation to restore and regenerate the damaged urethral sphincter and/or the construction of a neo-pubourethral ligament utilizing tissue engineering methodologies.
Publisher: Springer Science and Business Media LLC
Date: 06-1998
DOI: 10.1007/BF02001085
Publisher: Wiley
Date: 14-11-2006
Publisher: Springer Science and Business Media LLC
Date: 19-11-2004
DOI: 10.1007/S10029-004-0286-6
Abstract: The tissue reaction to implanted monofilamentous and multifilamentous polypropylene mesh was compared in s les removed at operation from the perivaginal area of a 58 year old patient. The fibrils of both were surrounded by collagenous connective tissue, collagen types I and III, and proteoglycans. Smaller, less compacted bundles were seen in the vicinity of the monofilamentous mesh than around the multifilamentous mesh, and in addition, a greater number of inflammatory cells and larger multinucleate giant cells were seen apposed to the monofilamentous mesh. Following this, eight rats were implanted with multifilamentous synthetic polypropylene tape and examined at two, four, six and eight weeks after surgery. Macrophages and multinucleated giant cells were seen in the immediate vicinity of the fibrils, while fibrovascular connective tissue surrounded the implantation site. These observations do not support the prevailing hypotheses that macrophages cannot penetrate between the fibrils of multifilament tape. They do suggest that differences in tensile strength may be present in the artificial neoligaments created by the two tapes.
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08033.X
Abstract: Abstract Seventeen women, 14 with urge incontinence, and 3 with with debilitating sensory urgency symptoms were operated on with a combined Intravaginal Sling operation and Tuck procedure. All but three were cured of their preoperative symptoms. The reason for the high cure rate achieved may be explained by restoration of anatomical support below the bladder neck. This prevents the stretch receptors from firing off at rest. Importantly, Intravaginal Sling operation and Tuck procedure do not elevate the bladder neck, so that these stretch ain receptors are not stimulated by the elevation process. The results accord with the Integral Theory of Female Urinary Incontinence, which states that urge as well as stress symptoms may derive from the same anatomical defect, a loose vagina.
Publisher: Wiley
Date: 02-2005
Publisher: Polish Urological Association
Date: 2018
Publisher: FapUNIFESP (SciELO)
Date: 04-2011
DOI: 10.1590/S1677-55382011000200012
Abstract: The aim of this study was to critically review the Arc-to-Arc mini-sling (Palma's technique) a less invasive mid-urethral sling using bovine pericardium as the sling material. The Arc-to-Arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. The technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. The ATFP (white line) was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. The initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. However, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. The Arc-to-Arc mini-sling was a good concept, but failed because of the poor technology available at that time. Further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2007
DOI: 10.1007/S10350-007-9067-5
Abstract: This study was designed to evaluate the outcome of transperineal rectocele repair using polyglycolic acid mesh. Eighty-three consecutive females with predominant, symptomatic Stage II or Stage III rectocele underwent transperineal rectocele repair using polyglycolic acid (Soft PGA Felt(R)) mesh and finished their six-month follow-up. No additional interventions, including levatoroplasty or perineorraphy, were performed. The preoperative and postoperative symptom scores and stages of the posterior vaginal wall prolapse were recorded. The end points were reassessed at six months, postoperatively. Preoperatively, 39 patients had Stage II and 44 patients had Stage III rectocele. The mean total symptom score was 9.87 +/- 1.93, which was reduced to 1.62 +/- 0.59 postoperatively (P < 0.0001). Objective evaluation of anatomic repair revealed that 74 patients (89.2 percent) had anatomic cure. Surgical complications were seen in a total of seven patients (8.4 percent), including hemorrhage (3.6 percent) and wound infection (4.8 percent). Mesh erosion, mesh infection, or worsening of sexual function was not noted. Transperineal repair of rectocele with the polyglycolic acid mesh is an efficient therapy for patients with rectocele. It is highly successful in eliminating symptoms of obstructed defecation, and it is free of significant complications.
Publisher: S. Karger AG
Date: 2010
DOI: 10.1159/000273458
Abstract: i Introduction: /i The human pelvic floor is a complex structure and pelvic floor dysfunction is seen frequently in females. i Materials and Methods: /i This review focuses on the surgical reconstruction of the pelvic floor employing recent findings on functional anatomy. A selective literature research was performed by the authors. i Results: /i Pelvic floor activity is regulated by 3 main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor organs, bladder and rectum. A variety of symptoms can derive from pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, fecal incontinence, obstructive bowel disease syndrome and pelvic pain. These symptoms mainly derive, for different reasons, from laxity in the vagina or its supporting ligaments as a result of altered connective tissue. Pelvic floor reconstruction is nowadays driven by the concept that in case of pelvic floor symptoms, restoration of the anatomy will translate into restoration of the physiology and ultimately improve patients’ symptoms. i Conclusion: /i The surgical reconstruction of the anatomy is almost exclusively focused on the restoration of the lax pelvic floor ligaments. Exact preoperative identification of the anatomical lesions is necessary to allow for exact anatomical reconstruction with respect to the muscular forces of the pelvic floor.
Publisher: Wiley
Date: 18-12-2014
DOI: 10.1002/NAU.22710
Publisher: Springer Science and Business Media LLC
Date: 15-01-2001
Abstract: The relative contributions of muscle forces and vaginal suspensory ligaments to the anatomical support of the vagina have been long disputed. The aim of this study was to gain further insights into the role of striated muscle forces. Fifty consecutive patients presenting to a pelvic floor clinic were tested with perineal ultrasound, lateral X-rays at rest and on straining, 10 ml of radio-opaque dye having been injected into bladder, vagina, rectum and, in 12 patients, into the levator plate also. The relevance of muscle forces to the three anatomical levels of support, the cardinal/uterosacral ligament complex (level 1), the rectovaginal fascia (level 2) and the perineal body (level 3), was analyzed. Biopsies of the suspensory ligaments were performed per vaginam. During effort, the upper part of the vagina was stretched backwards and downwards against the perineal body. Compression of level 2 on standing lateral X-ray appeared to be related to the angle of the upper vagina to the horizontal at rest. In 23 patients in whom the angle was 45 degrees or more to the horizontal, only 2 demonstrated significant angulation of the upper vagina and therefore compression of level 2 on straining. In contast, all 27 patients with an angle less than 45 degrees to the horizontal demonstrated both vaginal angulation and compression. Histology demonstrated smooth muscle and nerves in the suspensory ligaments, indicating an active contractile role for these structures. Analysis of the directional forces suggests that inability ot angulate the vagina sufficiently may predispose to herniations of the walls of the vagina owing to the twin influences of gravity and downward muscle forces exerted by the levator muscles.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2007
Publisher: Springer Science and Business Media LLC
Date: 07-01-2020
DOI: 10.1007/S00192-019-04183-6
Abstract: To compare anal sphincter damage in two groups of primigravid women in Sydney: one passively managed in public hospitals, the other more actively managed in adjacent private hospitals. Data from actively managed labours at the National Women's Hospital, Dublin, served as an independent control. We carried out a comparative study of third and fourth degree anal sphincter tears in all primiparas delivering at term in the years 2010-2015 in six Sydney public teaching hospitals with data from patients delivered in six adjacent Sydney private hospitals. A second comparator was published data from the National Women's Hospital, Dublin, where active management is still performed under the direction of midwives. All data was publicly available from www.health.nsw.gov.au/hsnsw . The difference between the two groups: public hospitals were under MANDATORY (NSW DG's upper case emphasis) direction from the Director General of NSW Health (PD 2010-045 File no 09/638-3) for labour to proceed without any augmentation. The study comprised 130,000 women. The mean third and fourth degree anal sphincter tear rate was 8.17% for the public hospitals and 1.52% for the private hospitals in the same period (p < 0.0003). Dublin's rate was 2.6%. There was no significant difference in the emergency Caesarean section rate 2010-2015 (13.7% private vs 12.7% public, 7.9% in National Women's Hospital Dublin) as well as an increase in epidurals, forceps/ventouse and lower Apgar scores. Passive management of labour instituted in Sydney public hospitals by government directive seems to be associated with a higher rate of obstetric anal sphincter injuries than was observed with active management. In addition, there were more epidurals, forceps/ventouse, and lower Apgar scores. Our hypothesis of deflexion of the head causing deficient powers is logically appealing, but needs further proof.
Publisher: Springer Science and Business Media LLC
Date: 02-1999
DOI: 10.1007/PL00004010
Abstract: A new classification specifies anatomical defects in the anterior, middle and posterior zones of the vagina as causing urinary dysfunction. An external musculoelastic mechanism stretches the vagina to open and close the outflow tract. The same pelvic floor muscles provide a peripheral control mechanism for micturition. The stretched vagina prevents the filling bladder from activating the stretch receptors. Vaginal laxity may weaken the transmission of muscle forces, interfering with the mechanical process of opening and closure. Laxity may also destabilize the peripheral control mechanism, a neurological process, causing bladder control to swing between the open and closed modes, i.e. bladder instability. Specific symptoms, signs and urodynamic tests were arranged into a pictorial algorithm as a practical guide for locating the three zones of anatomical defects. It was possible to reinterpret almost all the definitions and descriptions of the International Continence Society in terms of this classification, and to explain how vaginal laxity may cause premature activation of the micturition reflex (detrusor instability), stress incontinence and abnormal emptying (dribble, overflow). This convergence in anatomical and urodynamic (ICS) concepts explains many previously unexplained phenomena, and potentially opens up an entirely new approach to management, non-surgical strengthening of specific ligaments, or surgical reinforcement thereof with ambulatory 'keyhole' methods which do not require catheterization.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2007
DOI: 10.1007/S00192-007-0513-7
Abstract: The aim of the study was to analyse the dynamic anatomical supports of the posterior vaginal wall from the perspective of rectocele and rectal intussusception repair. Two groups of patients were studied. Group 1 (n = 24) with genuine stress incontinence but no major vault prolapse had vagino roctomyograms and transperineal ultrasound examinations. Group 2 with vaginal vault prolapse, clinical rectoceles and obstructive defecation symptoms (n = 19 had single-contrast defecating proctography before and after posterior-sling surgery. The posterior vaginal wall is suspended between perineal body, which underlies half its length, and uterosacral ligaments, which also support the anterior wall of rectum. Muscle forces stretch the vagina and rectum against the perineal body and uterosacral ligaments, creating shape and strength, like a suspension bridge. Postoperative proctogram studies indicated that anterior rectal wall intussusception has the same etiology as rectocele, deficient recto-vaginal ligamentous support. Repair to uterosacral ligaments and perineal body should be considered with large rectoceles, anterior rectal wall intussusception and obstructive defecation disorders.
Publisher: Springer Berlin Heidelberg
Date: 2010
Publisher: Wiley
Date: 07-1995
Publisher: Springer Science and Business Media LLC
Date: 22-05-2013
Publisher: Springer Science and Business Media LLC
Date: 16-09-2015
Publisher: S. Karger AG
Date: 2021
DOI: 10.1159/000515647
Abstract: A serendipitous cure in a 73-year-old woman of Hunner’s ulcer, urge, nocturia, apical prolapse by a tissue fixation system tensioned minisling (TFS) which reinforced the cardinal, and uterosacral ligaments (USLs) led us to analyse the relationship between Hunner’s ulcer and known pain conditions associated with USL laxity. The original intention was to cure the “posterior fornix syndrome” (PFS), uterine prolapse, and associated pain and bladder symptoms by USL repair. A speculum inserted preoperatively into the posterior fornix alleviated pain and urge symptoms, by mechanically supporting USLs. Hunner’s ulcer, along with pain and other PFS symptoms were cured by USL repair. The concept of USL laxity causing chronic pelvic pain and bladder problems is not new. It was published in the German literature by Heinrich Martius in 1938 and by Petros in the English literature in 1993. These findings raise important questions. As PFS symptoms are identical with those of interstitial cystitis (IC), are PFS and IC similar conditions? If so, then patients with IC who have a positive speculum test are at least theoretically, potentially curable by USL repair. These questions need to be explored.
Publisher: Wiley
Date: 11-2013
DOI: 10.1111/CODI.12333
Abstract: In many pelvic floor disorders, the perineal body is damaged or destroyed. There is still a considerable variation in anatomical descriptions of the perineal body and even more debate with regard to its attachments and relationships. Cadaveric dissections do not always reflect the functional behaviour of structures in the pelvis and description of live anatomy on imaging studies is not always reliable. This study aimed to define the anatomy of the perineal body in patients with rectocele during the live dissection required for minimally invasive surgical repair. From January 2007 to December 2009 consecutive patients requiring surgery for third-degree rectocele and symptoms of obstructed defaecation were recruited. Participants underwent dissection of the perineal body, rectum and vagina preliminary to a tissue fixation system, an operation which inserts a tensioned tape to repair the perineal body. Thirty Caucasian female patients, mean age 61 (range 47-87) years, mean parity 2.6 (range 1-5), were included. Live dissection demonstrated that the perineal body was ided into two parts, joined by a stretched central part, anchored laterally by the deep transverse perineii muscle to the descending ramus of the pubic bone. The mean longitudinal length of the perineal body was 4.5 (3.5-5.5) cm, accounting for 50% of the posterior vaginal support. In women with low rectocele, the perineal body appears to be ided into two parts, severely displaced behind the ischial tuberosities.
Publisher: Wiley
Date: 21-11-2013
DOI: 10.1111/CODI.12453
Abstract: We describe the technique of tissue fixation system (TFS) perineal body repair in patients presenting with symptomatic third degree rectocele. The single sling TFS perineal body repair is performed in three surgical steps: (i) dissection of the rectum off the vagina and laterally displaced perineal body (ii) identification of the deep transverse perineii muscles beyond their insertion point behind the descending pubic ramus (iii) elevation and approximation of the separated and laterally displaced perineal bodies by insertion, without tension, of non-stretch 7 mm polypropylene tape into the bodies of the deep transverse perineii muscles. From January 2007 to December 2009 we performed the TFS operation for 30 women, median age 61 (range 47-87) years, mean parity 2.6 (range 1-5), with third degree symptomatic low rectocele (median obstructive defaecation syndrome score 19 range 11-24). Median hospital stay was 24 (range 12-96) h. The median visual analogue scale for postoperative pain was 1 (range 1-7). Complications occurred in three cases (10%) and included a surfaced tape that was partly resected (repair maintained), a recurrence of the rectocele due to incorrect placement (failed repair) and a foreign body abscess requiring tape removal. At 12-month follow-up, 27 patients (90%) reported normal defaecation and the median obstructive defaecation syndrome score was significantly reduced to 4 (range 1-6 P < 0.001). The TFS perineal body repair is an effective, safe, minimally invasive treatment in women with symptomatic low rectocele.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2013
Publisher: Elsevier BV
Date: 04-1997
DOI: 10.1016/S0140-6736(05)62453-1
Abstract: The main objective of multilingual sentiment analysis is to analyze reviews regardless of the original language in which they are written. Switching from one language to another is very common on social media platforms. Analyzing these multilingual reviews is a challenge since each language is different in terms of syntax, grammar, etc. This paper presents a new language-independent representation approach for sentiment analysis, SentiCode. Unlike previous work in multilingual sentiment analysis, the proposed approach does not rely on machine translation to bridge the gap between different languages. Instead, it exploits common features of languages, such as part-of-speech tags used in Universal Dependencies. Equally important, SentiCode enables sentiment analysis in multi-language and multi-domain environments simultaneously. Several experiments were conducted using machine/deep learning techniques to evaluate the performance of SentiCode in multilingual (English, French, German, Arabic, and Russian) and multi-domain environments. In addition, the vocabulary proposed by SentiCode and the effect of each token were evaluated by the ablation method. The results highlight the 70% accuracy of SentiCode, with the best trade-off between efficiency and computing time (training and testing) in a total of about 0.67 seconds, which is very convenient for real-time applications.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2021
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08036.X
Abstract: Abstract Ten patients are presented with symptoms of urinary stress and/or urgency. Eight were cured by approximation of the uterosacral ligaments. This supports the contention of the Integral Theory of Female Urinary Incontinence that a loosely tethered supralevator vagina may be an important element in urinary incontinence, especially following hysterectomy.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2017
Publisher: Wiley
Date: 17-07-2022
DOI: 10.1002/NAU.24992
Publisher: Wiley
Date: 19-10-2022
DOI: 10.1002/NAU.25049
Abstract: To find a simpler cure for stress urinary incontinence (SUI) without tapes. Proposed is a paraurethral operation with incisions in both sulci to plicate pubourethral ligaments (PUL) with thick polyester sutures. VIDEO and ultrasound experiments showed the main cause of SUI was weak PULs extending on effort, allowing the posterior pelvic muscles to open out posterior urethral wall, so urine was lost on effort. Midurethral sling (MUS) tapes prevent PUL extension and SUI. The research question: "Would PUL plication by 0.5 or 0.25 mm polyester tapes create sufficient new collagen to cure SUI in the longer term?" Instron-testing of collagen from a rejected polyester aortic graft indicated sufficient potential collagen strength. Five surgeons unrelated to the authors who tested the new operation, reported negative cough tests on 30/31 women before patient discharge these data were encouraging, but not conclusive. PUL ligament repair by large polyester sutures, like the MUS, appears to prevent PUL elongation and cure SUI in the very short term, thereby validating the predictions of the Integral Theory as regards the role of ligaments in continence. If successful long term, this operation could avoid many problems associated with MUS operations. 1. Simplicity: less surgical skill is required the local anesthetic methodology makes the operation widely scalable especially in poor countries with few health facilities. 2. Built-in safety: there is no tape to compress urethra, no applicators to damage bladder, nerves, blood vessels, bowel. 3. Cost: a polyester suture.
Publisher: Wiley
Date: 16-06-2022
DOI: 10.1002/NAU.24990
Abstract: Parallel with the demographic ageing crisis, is a disabling overactive bladder (OAB) crisis (urgency/frequency/nocturia), 30% prevalence in older women, pathogenesis stated as unknown and, according to some learned societies, incurable. To review International Continence Society and Integral System paradigms to test our thesis that OAB per se is not a pathological condition, rather, a prematurely activated uncontrolled micturition pathogenesis being anatomical damage in a nonlinear feedback control system comprising cortical and peripheral (muscle/ligament) components. We examined studies from basic science, anatomy, urodynamics, ultrasonic and video xrays, ligament repairs, from which we created a nonlinear binary model of bladder function. We applied a Chaos Theory feedback equation, X next = Xc(1 − X) to test our hypothesis against existing concepts and hypotheses for OAB pathogenesis. The bladder has ONLY two modes, EITHER closed OR open (micturition). Closure is reflexly controlled cortically and peripherally: muscles contracting against ligaments stretch the vagina to suppress afferent signals to micturate from urothelial stretch receptors. “OAB” can be caused by anatomical damage anywhere in the model, by childbirth or age‐weakened ligaments, which can be repaired to cure all three OAB symptoms. Urodynamic “DO” graphs are interpreted anatomically and by the feedback equation. OAB is in crisis. Our thesis of OAB as an uncontrolled micturition from anatomical defects in the bladder control system provides fresh directions for further development of new treatments, nonsurgical and surgical, to help break the crisis and bring hope and cure to 600 million women sufferers.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2017
Publisher: Springer Science and Business Media LLC
Date: 17-05-2014
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000520629
Abstract: b i Hypothesis: /i /b A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. b i Methods: /i /b The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vectors around the PPL, with digital support for the PPL rectally and cadaveric testing with a tissue fixation system (TFS) minisling, and finally, 22 cases of postprostatectomy incontinence were addressed only with retropubic insertion of a 7-mm TFS sling between the bladder neck and perineal membrane to reinforce the PPL. b i Results: /i /b On ultrasound testing, 3 urethral closure muscles were confirmed to act reflexively around the PPL to close the urethra distally and at the bladder neck. A finger was inserted rectally, pressed against the symphysis only on one side of the urethra at the origin of the PPL that controlled urine loss on coughing. The mean pre-op pad loss was 3.8 pads at 9 months the mean post-op loss was 0.7 pads 13/22 (59%) patients were 100% improved 7/22 (31%) improved & #x3e % but & #x3c % 2/22 (9.1%) improved & #x3c %. b i Conclusions: /i /b The 7-mm-wide TFS minisling is the first retropubic minisling for postprostatectomy urinary incontinence. It differs significantly from transobturator male operations surgically and in modus operandi. As in the female, reconstruction of the PPL alone was sufficient to cure/improve SUI, suggesting that preservation of the PPL is of critical importance during retropubic radical prostatectomy.
Publisher: Wiley
Date: 22-02-2011
DOI: 10.1002/NAU.20969
Publisher: Springer Science and Business Media LLC
Date: 15-01-2001
DOI: 10.1007/PL00004039
Abstract: Our objective was to present and critically analyze the first 75 infracoccygeal sacropexy (ICS) operations for cure of vault prolapse. Level 1 reconstruction was achieved by the insertion of a tension-free vaginal tape (nylon) via the ischiorectal fossa into a transversely incised posterior vaginal fornix. Level 2 defects were repaired by cutting a central 'bridge' in the posterior vaginal wall and suturing the lateral flaps to the bridge. Level 3 repair reconstituted the perineal body. Postoperative pain was minimized by avoiding excessive tightening of tissues and avoiding surgery on the distal 1 cm of the vagina. Total operating time varied between 30 and 60 minutes. Mean blood loss was 120 ml. All patients were discharged within 24 hours of surgery, with minimal pain and without indwelling catheters. Almost all returned to normal activities within 7-10 days. Of the 75 patients (mean age 54 years), 71 were prospectively followed up between 1 and 4.5 years after surgery. Vault prolapse recurred in 6%. The main complication was tape erosion (5.3%). Infracoccygeal sacropexy is a promising day-case alternative to conventional methods. It has built-in safety, as it avoids pudendal nerves and vessels and surface rectal veins. Areas of future development are identified.
Publisher: Springer Science and Business Media LLC
Date: 13-03-2020
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1365-2753.2003.00344.X
Abstract: The whole spectrum of medicine consists of complex non-linear systems that are balanced and interact with each other. How non-linearity confers stability on a system and explains variation and uncertainty in clinical medicine is discussed. A major theme is that a small alteration in initial conditions may have a major effect on the end result. In the context of non-linearity, it is argued that 'evidence-based medicine' (EBM) as it exists today can only ever be relevant to a small fraction of the domain of medicine, that the 'art of medicine' consists of an intuitive 'tuning in' to these complex systems and as such is not so much an art as an expression of non-linear science. The main cause of iatrogenic disease is interpreted as a failure to understand the complexity of the systems being treated. Case study ex les are given and analysed in non-linear terms. It is concluded that good medicine concerns in idualized treatment of an in idual patient whose body functions are governed by non-linear processes. EBM as it exists today paints with a broad and limited brush, but it does promise a fresh new direction. In this context, we need to expand the spectrum of scientific medicine to include non-linearity, and to look upon the 'art of medicine' as a historical (but unstated) legacy in this domain.
Publisher: IEEE
Date: 2000
Publisher: Elsevier BV
Date: 10-2010
Publisher: Wiley
Date: 16-02-2022
DOI: 10.1002/NAU.24889
Abstract: To present an anatomical pathogenesis parallel with the 2002 International Continence Society Lower Urinary Tract (LUTS) definitions standardization Report 2002. Each LUTS section is discussed using the same numbers as the Report. Normal function Bladder control is binary, with two reflexes alternating, either closure (dominant) or open (micturition), with the same cortical and peripheral components: three directional muscle forces contracting against pubourethral (PUL) and uterosacral (USL) ligaments for closure, two against uterosacral ligaments for micturition. Dysfunction OAB symptoms reflect a prematurely activated micturition PUL/USL weakness prevents muscle forces from controlling afferent urothelial emptying signals. Stress urinary incontinence is a consequence of weak PULs allowing posterior muscle forces to open the urethra during effort. Lax USLs weaken contractile force of the posterior urethral opening vectors, so detrusor has to contract against an unopened urethra. This is experienced as “obstructive micturition.” Anatomical analysis indicates the ICS definitions are fundamentally sound, except for “OAB” which implies detrusor causation. Minor changes, OAB to “overactivated” bladder allow causation outside of bladder. This construct supports OAB and its component symptoms as a syndrome, as intuited by the Committee, (albeit as a prematurely activated micturition), retains the acronym, explains OAB cure by ligament repair, and incontinence pathogenesis from two post‐2002 syndromes which need an addition to the definitions, Posterior Fornix Syndrome (of which OAB is a component) and Tethered Vagina Syndrome, which is the basis for skin‐grafting cure of the 30%–50% of women who continue leaking urine massively after successful obstetric fistula closure.
Publisher: Springer Science and Business Media LLC
Date: 27-09-2006
Publisher: S. Karger AG
Date: 1998
DOI: 10.1159/000010035
Abstract: b Aims: /b To examine why anatomical correction of a cystocele may cause stress incontinence in a patient with no prior history of this condition. b Methods: /b The study group consisted of 5 patients, aged 45–63 years, with stress incontinence induced by supporting a cystocele with a pessary. The patients were otherwise continent. Testing was performed in a semirecumbent sitting position under perineal ultrasound control. The patients were asked to strain and cough before and after supporting the bladder neck with both sponge-holding forceps and a ring pessary. b Results: /b In all 5 patients, urine loss on stress was noted with bladder base support by forceps and pessary insertion. With both, asymmetrical downward stretching of the vagina and bladder base was observed. When the cystocele was allowed to balloon outwards, the asymmetrical pattern converted to a symmetrical ‘funnelling’ of the anterior and posterior walls of bladder neck. b Conclusion: /b This study appears to support the hypothesis that, in addition to urethral narrowing, a ballooning cystocele may restore urethral closure by removing laxity from the vaginal hammock. Correction of a cystocele may cause incontinence by removing a fortuitous, but abnormal compensatory mechanism.
Publisher: Elsevier BV
Date: 05-2019
Publisher: AMPCo
Date: 07-1994
DOI: 10.5694/J.1326-5377.1994.TB127360.X
Abstract: Iron accumulates with age in the normal human brain. This process is altered at several levels in the brain of multiple sclerosis (MS) patients. Since iron is mainly stored in oligodendrocytes and myelin in the normal brain, its liberation in demyelinating lesions may lify tissue damage in demyelinating lesions and its uptake in macrophages and microglia may help to more precisely define activity stages of the lesions. In addition, glia cells change their iron import, export and storage properties in MS lesions, which is reflected by alterations in the expression of iron transport molecules. Changes of iron distribution in the brain can be reliably detected by MRI, particularly upon application of Ultra-high magnetic field (7 Tesla). Iron-sensitive MRI allows to more accurately distinguish the lesions in MS from those in other inflammatory brain diseases, to visualize a subset of slowly expanding lesions in the progressive stage of MS and to increase the sensitivity for lesion detection in the gray matter, such as the cerebral cortex or deep gray matter nuclei.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Wiley
Date: 20-09-2014
DOI: 10.1111/AOGS.12500
Publisher: Wiley
Date: 12-2005
Publisher: Wiley
Date: 11-1996
DOI: 10.1111/J.1479-828X.1996.TB02192.X
Abstract: The aim was to evaluate the intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence. Fifty-four unselected patients, aged from 26 to 79 years, mainly with mixed incontinence symptoms, underwent this procedure. It works by tightening the suburethral vagina ('hammock'), and by creating an artificial pubourethral neoligament. Where indicated, repair of uterine prolapse (24 cases), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, without requirement for postoperative catheterization, and returned to fairly normal activities, including jobs, within 7 to 14 days. At a mean follow-up time of 15 months, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress incontinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction of mean residual urine from 67.5 mL to 32 mL. The objective cure rate (exercise pad testing) for stress incontinence was 88.6% taking the group as a whole, urine loss was reduced from a mean of 11.6 g preoperatively to a mean of 0.5 g postoperatively. Urodynamically diagnosed detrusor instability was not a predictor of surgical failure in this study. According to the concepts presented here, symptoms of urinary dysfunction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to correct these defects are fairly simple, safe and easily learnt by an practising gynaecologist.
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08035.X
Abstract: Abstract Six patients, average age 80 years, with no previous operations, presented with urinary incontinence. The predominant symptoms were “being wet all the time” and “sudden uncontrolled urine loss”. They had no symptoms of urgency or stress incontinence, and no objective evidence of “detrusor instability” or urine loss on cough stress pad testing. All but one patients were cured by the simultaneous combined Intravaginal Sling and Tuck operation, indicating that the primary cause of the symptoms was an anatomical defect in the vagina and the ligamentous supports in the region of the bladder neck, as stated in the Integral Theory of Urinary Incontinence, this supplement, elderly.
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000524321
Abstract: b i Background: /i /b The posterior fornix syndrome (PFS) was first described in 1993 as a predictably occurring group of symptoms: chronic pelvic pain (CPP), urge, frequency, nocturia, emptying difficulties/urinary retention, caused by uterosacral ligament (USL) laxity, and cured by repair thereof. b i Summary: /i /b Our hypothesis was that non-Hunner’s interstitial cystitis (IC) and PFS are substantially equivalent conditions. The primary objective was to determine if there was a causal relationship between IC and pelvic organ prolapse (POP). The secondary objective was to assess whether other pelvic symptoms were present in patients with POP-related IC and if so, which ones? How often did they occur? A retrospective study was performed in 198 women who presented with CPP, uterine/apical prolapse (varying degrees), and PFS symptoms, all of whom had been treated by posterior USL sling repair. We compared their PFS symptoms with known definitions of IC, CPP, and bladder symptoms. To check our hypothesis for truth or falsity, we used a validated questionnaire, “simulated operations” (mechanically supporting USLs with a vaginal speculum test to test for reduction of urge and pain), transperineal ultrasound and urodynamics. b i Key Messages: /i /b 198 patients had CPP and 313 had urinary symptoms which conformed to the definition for non-Hunner’s IC. The cure rate after USL sling repair was CPP 74%, urge incontinence 80%, frequency 79.6%, abnormal emptying 53%, nocturia 79%, obstructive defecation 80%. Our findings seem to support our hypothesis that non-Hunner’s IC and PFS may be similar conditions also, non-Hunner IC/BPS may be a separate or lesser disease entity from “Hunner lesion disease”. More rigorous scientific investigation, preferably by RCT, will be required.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2018
Publisher: Wiley
Date: 23-02-2011
DOI: 10.1002/NAU.21023
Publisher: Elsevier BV
Date: 07-2018
Publisher: Wiley
Date: 23-09-2004
Publisher: Springer Science and Business Media LLC
Date: 24-06-2017
Publisher: Elsevier BV
Date: 10-1994
Publisher: Wiley
Date: 29-10-2010
DOI: 10.1002/NAU.20902
Publisher: Springer Science and Business Media LLC
Date: 28-10-2016
Publisher: Springer Science and Business Media LLC
Date: 04-2004
DOI: 10.1007/S00192-003-1112-X
Abstract: The split labium minus flap graft technique was used to restore tissue volume and therefore elasticity into the bladder neck area of vagina in eight patients. Three full-thickness vaginal incisions were made, a longitudinal incision extending from external urethral meatus to 3-4 cm beyond the bladder neck, and two transverse incisions, one just below the external urethral meatus and the other at the level of the bladder neck. The vagina, urethra and bladder neck were mobilized widely and the suburethral flaps rotated downwards, leaving a bare area below the urethra. A transverse incision was made across the base of one labium minus (LM) and the incision carried up on each side to the ridge of the LM. The inner wall was dissected clear of the outer wall, creating a flap. This was then rotated into the bare area formed by dislocation of the suburethral vagina. The flap was attached to the pubococcygeus muscles laterally, to the external meatus superiorly and to the vaginal skin inferiorly. All the cut surfaces of the vagina and LM were joined with 00 Dexon sutures. Postoperative pain was minimal. All patients were discharged within 48 h, and there was excellent anatomical restoration at 6 weeks' follow-up. The technique works well in patients with adequately large labia minora, and has potential uses for patients who have deficient vaginal tissue in the hammock or bladder neck areas of the vagina.
Publisher: Springer Science and Business Media LLC
Date: 22-10-2010
Publisher: FapUNIFESP (SciELO)
Date: 04-2010
DOI: 10.1590/S1677-55382010000200012
Abstract: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. A total of 30 female patients with stress urinary incontinence (SUI), anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.
Publisher: Polish Urological Association
Date: 2012
Publisher: Wiley
Date: 14-09-2005
Publisher: Springer Science and Business Media LLC
Date: 26-02-2018
Publisher: Springer Science and Business Media LLC
Date: 09-03-2020
Publisher: Informa UK Limited
Date: 03-1995
DOI: 10.3109/00365599509180543
Abstract: A new ambulatory procedure for treatment of female urinary incontinence (intravaginal slingplasty, IVS) was performed on 50 patients. In all patients the surgical procedure was carried out under local anaesthesia and without postoperative urinary catheterization. The technique has been elaborated from previous experimental and clinical studies and aims at restoration of the pubourethral ligament and the suburethral vaginal hammock. Thirty-eight patients suffered from genuine stress incontinence as objectively verified and 12 patients had symptoms and signs of both urge and stress incontinence. Thirty-nine (78%) patients were completely cured from their stress incontinence symptoms. Another six patients (12%) reported a considerable improvement of their urinary incontinence leaking only occasionally. Concerning urge incontinence symptoms a significant relief of the symptoms was obtained in 6 of 12 patients. No intra- or post-operative complications occurred.
Publisher: Polish Urological Association
Date: 2011
Publisher: Springer Science and Business Media LLC
Date: 11-1999
Abstract: The aim was to prospectively follow a group of 25 patients (mean age 60.5 years) presenting with double incontinence, urinary and fecal. Other than endoanal ultrasound, no allowance was made for fecal incontinence. All patients were treated exclusively according to an anatomical classification used for the management of urinary incontinence. Initially, all patients underwent surgical reconstruction of their pubourethral neoligaments with intravaginal slingplasty. All 25 patients reported complete cure of their fecal incontinence for a minimum of 6 months (mean 26 months, range 6-48 months) after surgery, and 22 patients of their urinary incontinence as well. The external anal sphincter was normal in all 25 patients (100%). The internal anal sphincter (IAS) was normal in 18 patients (72%). In 3 patients fecal incontinence recurred simultaneously with the occurrence of herniations in the posterior and middle parts of the vagina. Subsequent surgical repair of the uterosacral and arcus tendineus fasciae pelvis ligaments cured the recurrence. The results appear to indicate that non-traumatic ('idiopathic') fecal incontinence may have the same cause as urinary incontinence. As only connective tissue was repaired, it is suggested that connective tissue damage may be an important cause of fecal as well as urinary incontinence.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2018
Publisher: Elsevier BV
Date: 04-2018
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08030.X
Abstract: Abstract A minor operative procedure involving the excision of bilateral small elliptical 1 × 0.5 cm pieces of vaginal mucosa is described as a proposed alternative to a Kelly Repair. Twelve month success rate was 47%. The modus operandi of the procedure is examined with reference to the Integral Theory of Female Urinary Incontinence, as are the possible reasons for the operative failure.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 09-1996
DOI: 10.1007/BF01901252
Abstract: Emerging evidence reveals that the stimulator of the interferon genes (STING) signaling pathway in insects and other animal cells helps them to sense and effectively respond to infection caused by numerous types of microbial pathogens. Recent studies have shown that genomic material from microbial pathogens induces the STING signaling pathway for the production of immune factors to attenuate infection. In contrast, microbial pathogens are equipped with various factors that assist them in evading the STING signaling cascade. Here we discuss the STING signaling pathway different animal groups compared to human and then focus on its crucial biological roles and application in the microbial infection of insects. In addition, we examine the negative and positive modulators of the STING signaling cascade. Finally, we describe the microbial pathogen strategies to evade this signaling cascade for successful invasion.
Publisher: Wiley
Date: 1990
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1978
Publisher: Wiley
Date: 2001
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: S. Karger AG
Date: 1998
DOI: 10.1159/000009935
Abstract: b Objectives: /b To prospectively test the hypothesis that laxity in the posterior ligaments of the vagina may cause raised residual urine and abnormal emptying symptoms. b Methods: /b Eighteen patients, 16 multiparous, and 2 nulliparous, were referred with symptoms of abnormal bladder emptying. All were assessed with standard cystometry and standing resting and straining lateral X-ray films, with the bladder containing a Foley balloon catheter containing 10 ml of radio-opaque dye. Three patients were also assessed with videocystourethrograms, and these were compared to 4 normal controls. A posterior fornix repair was performed. A full thickness horizontal vaginal incision was made using a scalpel. The incision was stretched antero-posteriorly, and the utero-sacral and cardinal ligaments tightened by suturing them side to side. b Results: /b Specific symptoms of defective opening were reduced from a total of 43 pre-operatively to 9 post-operatively. Mean residual urine was reduced from 98.7 to 31.7 ml (p ≤ 0.028). Peak flow increased from 29.7 to 34.2 ml/s, p ≤ 0.08. Mean flow pre-operative was 8.18 ml/s, and post-operative flow 8.6 ml/s (p ≤0.88). Mean emptying time decreased from 65.3 to 60.4 s. b Conclusions: /b Reference to radiographs in normal patients demonstrates that bladder funnelling is associated with a powerful downward force transmitted to the coccyx via the utero-sacral ligaments. Correction of laxity in the utero-sacral ligaments, the effective insertion points of the downward force, improved bladder emptying. This appears to sustain the hypothesis that abnormal bladder emptying in the female may be at least partly caused by ineffectiveness of the opening muscles, because of laxity in their insertion points.
Publisher: Wiley
Date: 04-2006
Publisher: Elsevier BV
Date: 02-1997
DOI: 10.1016/S0140-6736(05)61219-6
Abstract: The microbial communities in animal digestive systems are critical for host development and health. They stimulate the immune system during development, synthesize important chemical compounds like hormones, aid in digestion, competitively exclude pathogens, etc. Compared to the bacterial and fungal components of the microbiome, we know little about the temporal and spatial dynamics of bacteriophage communities in animal digestive systems. Recently, the bacteriophages of the honey bee gut were characterized in two European bee populations. Most of the bacteriophages described in these two reports were novel, harbored many metabolic genes in their genomes, and had a community structure that suggests coevolution with their bacterial hosts. To describe the conservation of bacteriophages in bees and begin to understand their role in the bee microbiome, we sequenced the virome of Apis mellifera from Austin, TX, and compared bacteriophage compositions among three locations around the world. We found that most bacteriophages from Austin are novel, sharing no sequence similarity with anything in public repositories. However, many bacteriophages are shared among the three bee viromes, indicating specialization of bacteriophages in the bee gut. Our study, along with the two previous bee virome studies, shows that the bee gut bacteriophage community is simple compared to that of many animals, consisting of several hundred types of bacteriophages that primarily infect four of the dominant bacterial phylotypes in the bee gut.
Publisher: Wiley
Date: 1995
Abstract: The aim of the study was to determine the contribution of intra-abdominal pressure transmission to urinary continence in the female. Five patients with genuine stress incontinence (GSI) were studied. Pressure transmission was measured in equivalent positions inside and outside the urethra and bladder during the Intravaginal Slingplasty procedure, a surgical operation used for treatment of urinary incontinence, and performed under local anaesthesia. A 6 mm diameter channel was created alongside the urethra. Two separate microtransducer catheters appropriately marked for length were inserted, one inside the urethra, and the other inside the described channel. With the vaginal hammock intact, an average of 10 simultaneous pressure measurements were made intraoperatively in response to coughing and straining in equivalent positions inside the urethra, and directly outside. Significantly higher pressure readings were found inside the urethra (P = 0.0025), indicating that an active component within the urethra may have created this pressure rise. After opening out two suburethral vaginal flaps, large quantities of urine were lost on coughing in all patients. Continence was achieved on tightening the suburethral vagina, indicating that an adequately tight vaginal hammock is a critical element in the continence process. The findings of this study question intraabdominal pressure as a mechanism contributing to continence, but support an alternative mechanism, musculovaginal closure of the urethra.
Publisher: Wiley
Date: 05-2013
DOI: 10.1002/NAU.22417
Publisher: Wiley
Date: 2007
DOI: 10.1002/NAU.20478
Publisher: Wiley
Date: 2005
DOI: 10.1002/NAU.20116
Publisher: Springer Milan
Date: 2010
Publisher: Wiley
Date: 23-10-2015
DOI: 10.1111/AOGS.12716
Publisher: Springer Science and Business Media LLC
Date: 19-02-2015
DOI: 10.1007/S00192-015-2639-3
Abstract: The discovery of tension-free vaginal tape (TVT) began in 1986 with two unrelated observations: pressure applied unilaterally at the midurethra controlled urine loss on coughing implanted Teflon tape caused a collagenous tissue reaction. In 1987, Mersilene tape was implanted retropubically in 13 large dogs, with the aim of creating an artificial collagenous pubourethral neoligament. Extensive testing showed that the operation was safe and effective. In 1988-1989, human testing was carried out (n = 30). Mersilene tape cured 100 % of stress and mixed incontinence with a sling in situ however, there was simultaneous recurrence of the two symptoms in 50 % on sling removal. X-rays showed no elevation of the bladder neck. In 1990-1993, collaboration with Ulf Ulmsten took place: a permanently implanted tape was required. Polypropylene was the ideal material. In 2003, the neoligament principle was applied as an adjustable "micro" sling to the arcus tendineus fasciae pelvis (ATFP), cardinal, uterosacral ligaments, and perineal body for cure of cystocele, rectocele, and apical prolapse. It was found that symptoms such as urgency, nocturia, chronic pelvic pain, obstructive defecation syndrome (ODS), and fecal incontinence were frequently cured or improved. The lecture concluded with advice to younger members. Without new paradigms, there are no randomized controlled trials, no meta-analyses, Cochrane. Indeed, no progress. Be open to new concepts. Read Kuhn's "The Structure of Scientific Revolutions" to understand the discovery process. Examine the relationship among symptoms, ATFP, cardinal, uterosacral ligaments, and the perineal body. This is the next paradigm. Don't disregard anomalies. Pursue them. They are the pathway to discovery. Innovation is born from challenge, not conformity. Persist, even when meeting resistance. Resistance is a sign that your discovery is important.
Publisher: Wiley
Date: 21-09-2012
DOI: 10.1002/NAU.22308
Abstract: We analyzed our original experimental studies on which the midurethral sling was based with reference to FDA mesh warnings. We concluded that: 1. Vascular/organ damage could be avoided by first penetrating the urogenital diaphragm. 2. A non-stretch tape minimizes obstruction and urethral damage. 3. A non-obstructive musculoelastic mechanism closes the urethra. 4. The strength of neocollagen (>92.8 lbs/sq inch) indicates that little mesh is required for prolapse repair. 5. Foreign body (mesh) reaction is different from infection and is related to volume implanted. 6. Urgency is potentially curable by repairing the suspensory ligaments. 7. "Minislings" are promising for incontinence and POP, but more development is required.
Publisher: Wiley
Date: 14-09-2005
Publisher: Springer Science and Business Media LLC
Date: 11-02-2022
DOI: 10.1007/S00404-022-06424-4
Abstract: This short opinion aimed to present the evidence to support our hypothesis that vulvodynia is a neuroinflammatory pain syndrome originating in the pelvic visceral nerve plexuses caused by the failure of weakened uterosacral ligaments (USLs) to support the pelvic visceral nerve plexuses, i.e., T11–L2 sympathetic and S2–4 parasympathetic plexuses. These are supported by the USLs, 2 cm from their insertion to the cervix. They innervate the pelvic organs, glands, and muscles. If the USLs are weak or lax, gravitational force or even the muscles may distort and stimulate the unsupported plexuses. Inappropriate afferent signals could then be interpreted as originating from an end-organ site. Activation of sensory visceral nerves causes a neuro-inflammatory response in the affected tissues, leading to neuroproliferation of small peripheral sensory nerve fibers, which may cause hyperalgesia and allodynia in the territory of the damaged innervation. Repair of the primary abnormality of USL laxity, responsible for mechanical stimulation of the pelvic sensory plexus, may lead to resolution of the pain syndrome.
Publisher: Wiley
Date: 16-06-2011
Publisher: Springer Science and Business Media LLC
Date: 06-07-2021
Publisher: Wiley
Date: 11-1993
DOI: 10.3109/00016349309021161
Abstract: The principal aim of this study was to analyse the simultaneous pressure readings derived from bladder and urethra during a handwashing test. A total of 163 patients with urinary incontinence were studied. It was demonstrated that contraction of the pelvic floor stretches the vagina. In many patients, this appeared to inhibit the micturition reflex, possibly by supporting the nerve endings at bladder neck, thereby inhibiting their premature activation. There was also evidence that this stretching activated reflex contraction of the urethra, the vagina-urethral (coital) reflex, thereby increasing the urethral resistance. On further analysis, it was concluded that urodynamic testing does not detect 'detrusor instability' per se. It detects the urethra's attempts at closure.
Publisher: Wiley
Date: 04-08-2022
DOI: 10.1002/NAU.25013
Abstract: A firm pubourethral ligament (PUL) is required to prevent the reflex posterior pelvic muscle forces forcibly opening out the posterior urethral wall on effort. A weak or loose PUL elongates on effort and this allows the posterior pelvic muscles to stretch open the posterior urethral wall causing urine loss, “stress urinary incontinence.” Such forcible opening out of the urethra exponentially reduces the urethral resistance to flow inversely by the fourth power of the radius (i.e., 16 times). For ex le, if the radius doubles in size, the bladder pressure required for urine to flow out decreases by a factor of 16, from say, 160 to 10 cm H 2 O. A midurethral sling reinforces PUL to prevent the urethra opening out, thereby restoring both the distal urethral and bladder neck closure mechanisms.
Publisher: Springer Science and Business Media LLC
Date: 09-03-2013
Publisher: Wiley
Date: 12-2001
Publisher: Springer Science and Business Media LLC
Date: 24-07-2012
DOI: 10.1007/S10151-012-0860-3
Abstract: The aim of this study was to test our hypothesis that the reason why imaging is of little assistance in diagnosing "constipation" causes may be related to the high sensitivity of internal anorectal flow resistance in defecation to small changes in geometry. We applied a mathematical model to describe the effects on flow mechanics of observed changes in the shape of the rectum and anus during defecation. Three groups of patients were studied with video proctograms. Group 1 comprised 4 patients with normal defecation studied with video proctography or magnetic resonance imaging (MRI). Group 2 comprised 8 patients with fecal incontinence, studied by video X-ray electromyography. Group 3 comprised 8 patients with constipation evaluated by video MRI. Three muscle vectors open the anorectal angle prior to defecation, causing the anorectal luminal diameter to increase to approximately twice its resting size. These vectors are forwards (anterior wall), backwards and downwards (posterior wall). Resistance to passage of a fecal bolus through the anorectum is determined by viscous friction against the anorectal wall and by the energy required to deform the bolus as it flows. The observed changes in anorectal geometry serve to reduce both the viscous friction in the anus and the deformation of the bolus, which reduces the force required to facilitate its passage through the anus. For ex le, if the effective diameter of the anus is doubled during defecation, the frictional resistance is reduced by a factor of 8. The sensitivity of flow resistance to geometry explains why MRI or computed tomography (CT) scans taken during defecation are not often helpful in diagnosing causation. Small changes in geometry can have a disproportionate affect on flow resistance. Combining accurate directional measurements during dynamic MRI or CT scans taken during defecation with observations of bolus deformation, and if possible, simultaneous anorectal manometry, may provide clinically helpful insights on patients with anorectal evacuation disorders.
Publisher: Wiley
Date: 10-12-2010
Publisher: Wiley
Date: 05-2013
DOI: 10.1002/NAU.22422
Publisher: Springer Science and Business Media LLC
Date: 18-04-2013
Publisher: Springer Milan
Date: 2010
Publisher: Springer Science and Business Media LLC
Date: 20-02-2015
Publisher: Galenos Yayinevi
Date: 20-08-2021
Publisher: Springer Science and Business Media LLC
Date: 26-05-2011
DOI: 10.1007/S00192-011-1449-5
Abstract: "Mixed incontinence" is defined as a combination of stress and urge symptoms. Over time, it has morphed into a single entity, encompassing etiology and treatment. My perspectives are: (a) Stress incontinence (SI) and urge incontinence (UI) are different symptoms with often different anatomical causation and so should be treated separately (b) It is illogical to group urgency with SI. Urgency may also be associated with frequency, nocturia, abnormal emptying and pelvic pain in patients with no SI ("posterior fornix syndrome") and (c) There is growing evidence that urgency may be cured by surgical correction of a cystocele and/or apical prolapse in up to 80% of patients who do not have SI. In this anatomical context, sensory urgency, urge incontinence and urodynamic detrusor overactivity may all be hypothesized as different manifestations of a prematurely activated micturition reflex, caused by a lax vagina's inability to support bladder base stretch receptors. This statement can be tested with a simple clinical test, "simulated operations", whereby digitally supporting in turn the midurethra, bladder base and posterior vaginal fornix may cause a significant decrease in the urgency felt by the patient. The term "mixed incontinence" is only valid if both symptoms are caused by a lax pubourethral ligament. However, urgency may be caused by laxity in other parts of the vagina. Regarding stress and urge as separate entities will remove the confusion resulting from this definition, creating new directions for science and therapy.
Publisher: Springer Science and Business Media LLC
Date: 03-1997
DOI: 10.1007/BF02764821
Publisher: Springer Science and Business Media LLC
Date: 03-1997
DOI: 10.1007/BF02764822
Publisher: Wiley
Date: 29-07-2009
Publisher: Wiley
Date: 1990
Publisher: S. Karger AG
Date: 1993
DOI: 10.1159/000292592
Abstract: A group of 163 patients attending with a naturally full bladder had urethrocystometric assessment during provocation with a handwashing test. The results were compared with those from a similar group of 169 patients who were subjected to a handwashing test following the infusion of 500 ml of saline with fast-fill cystometry. The latter group was found to have an unacceptably high number of false-positive results. Also, the results appear to indicate that urine loss due to uncontrolled detrusor contraction may be mainly due to premature activation of the micturition reflex. A fall in the intraurethral pressure was found in 79% and a rise in detrusor pressure in 49% of the patients presenting with a prior history of an unstable bladder. Natural urethrocystometry appears to be a useful and informative technique for objectively assessing patients with a prior history of bladder instability.
Publisher: Springer Science and Business Media LLC
Date: 09-1997
DOI: 10.1007/BF02765483
Abstract: The electrocoagulation method using stainless steel anodes was applied to a corrugated cardboard box manufacturing plant's wastewater with high COD content. The effects of current density, processing time and stirring speed on response functions were studied using the Response Surface Methodology (RSM). The removal efficiency of chemical oxygen demand (COD) and energy consumption were selected as response functions. The Central Composite Design (CCD) was chosen to explain the single and combined effects of independent variables on response functions. The COD concentration of the real industrial wastewater used in the experiments was 9130 mg L
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-1992
Publisher: Elsevier BV
Date: 02-2001
DOI: 10.1016/S0301-2115(00)00313-4
Abstract: A new approach to pelvic floor rehabilitation is presented. The aim was to strengthen the three directional muscle forces observed during effort along with their ligamentous insertions. A new anatomical classification guided diagnosis of anatomical defects in the anterior, middle and posterior compartments of the vagina. Where relevant, HRT was administered to prevent long-term collagen loss. Electrotherapy, fast and slow twitch exercises strengthened the striated muscles of the pelvic floor and, therefore, their insertions also. Sixty patients aged 15--86 (mean age: 55 years) were independently assessed at the end of the 3 month programme using the same semiquantitative questionnaire and self-assessment. The median improvement rate per symptom was 65%. Symptom improvement was: stress incontinence,78% urgency, frequency, 61% nocturia, 75% pelvic pain of unknown origin, 65% involuntary leakage, 68% and bowel problems, 78%. Three patients reported significant worsening of their stress symptoms. This method potentially broadens the conditions amenable to nonsurgical therapy. The preliminary results are promising, and appear to sustain the theory on which they are based. More objective and longer term data, and especially, comparative testing of this regime by other investigators is required.
Publisher: Wiley
Date: 21-12-2018
DOI: 10.1002/NAU.23888
Abstract: To summarize the mechanics of urethral closure, incontinence, and midurethral sling repair, a work in 3 parts Part 1. Original scientific studies (1990). Part 2. Experimental validation of reliance of the closure mechanisms on a competent PUL (1993-2003). Part 3. Surgery (1990-2016). Part1. Two unrelated observations in the mid 1980s led to the discovery of the MUS: a hemostat applied on one side of the midurethral area of the vagina, controlled urine loss on coughing without bladder neck elevation an implanted Teflon tape cause a collagenous reaction. It was hypothesized that urinary stress incontinence (USI) was caused by collagen loss in the pubourethral ligament (PUL) and a tape implanted in the exact position of PUL would reinforce it and cure USI. A tape removable at 6 weeks was configured as an inverted "U" in the vagina and lowered sequentially. At a certain point, the patient was continent on coughing but was able to pass urine freely. This proved the mechanism for continence was not obstructive. Post-op xrays showed no elevation of bladder neck. This invalidated Enhorning's Theory. Ultrasound showed closure of distal urethra from behind and descent of vaginal fornix on straining. This indicated there were two closure mechanisms, distal urethral, and bladder neck. Three months following sling removal, there was a 50% failure rate. The 1990 results indicated a permanent sling was required for the MUS. Further proofs were required for the proposed musculoelastic mechanisms.
Publisher: Galenos Yayinevi
Date: 20-08-2021
Publisher: Springer Science and Business Media LLC
Date: 21-08-2015
Publisher: Wiley
Date: 06-1999
Publisher: Wiley
Date: 06-2013
DOI: 10.1111/AJO.12086
Publisher: Springer Science and Business Media LLC
Date: 1998
DOI: 10.1007/BF01900537
Abstract: High-N Ni-free stainless steels are used for their excellent mechanical properties combined with their high corrosion resistance, especially for biomedical applications. Even though it is well-known that secondary hardening during annealing after cold working has been observed in many materials, this phenomenon was not reported for these materials, one of the best known being Biodur108©, although numerous efforts have been made to increase its hardness. In this work, thermomechanical treatments at low temperature of cold-deformed Biodur108© were conducted to increase the hardness. Hardness as high as 830 Hv was obtained. For this material, the annealing of a deformed s le at intermediate temperature leads to a secondary hardening phenomenon. The mechanisms responsible for this secondary hardening were analyzed. It was found that for deformed s les, annealing at 575 °C leads to the formation of small Cr
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
Publisher: Springer Science and Business Media LLC
Date: 10-04-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
Publisher: Springer Science and Business Media LLC
Date: 14-08-2012
DOI: 10.1007/S10151-012-0861-2
Abstract: We conducted an observational study to assess the hypothesis that the pelvic muscles actively open the anorectal lumen during defecation. Three groups of female patients were evaluated with video imaging studies of defecation using a grid or bony reference points. Eight patients with idiopathic fecal incontinence had video myogram defecography eight with obstructive defecation had magnetic resonance imaging (MRI) defecating proctograms and four normal patients had video X-ray or MRI defecating proctogram studies. In all three groups, the anorectum was stretched bidirectionally by three directional muscle force vectors acting on the walls of the rectum, effectively doubling the diameter of the rectum during defecation. The anterior rectal wall was pulled forwards, and the posterior wall backwards and downwards opening the anorectal angle, associated with angulation of the anterior tip of the levator plate (LP). These observations are consistent with a staged relaxation of some parts of the pelvic floor during defecation, and contraction of others. First, the puborectalis muscle relaxes. Puborectalis muscle relaxation frees the posterior rectal wall so that it can be stretched and opened by contraction of the LP and conjoint longitudinal muscle of the anus. Second, contraction of the pubococcygeus muscle pulls forward the anterior rectal wall, further increasing the diameter of the rectum. Third, when the bolus has entered the rectum, the external anal sphincter relaxes, and the rectum contracts to expel the fecal bolus. Our results are consistent with the hypothesis that pelvic striated muscle actively opens the rectal lumen, thereby reducing internal anorectal resistance to expulsion of feces. Controlled studies of electromyographic activity would be useful to further test this hypothesis.
Publisher: Springer Science and Business Media LLC
Date: 25-09-2017
Publisher: Springer Science and Business Media LLC
Date: 29-03-2022
Publisher: Wiley
Date: 1993
Abstract: Urethrocystometry was performed during a provocative handwashing test in 163 patients, 115 of whom had a prior history of urge incontinence. Almost invariably, a rise in detrusor pressure, when present, followed a fall in urethral pressure, and both were preceded by urge symptoms. This pattern appears to conform to the concept of "urethral instability", "detrusor instability" and urge incontinence being different manifestations of a prematurely activated micturition reflex.
Publisher: Polish Urological Association
Date: 2018
Publisher: Elsevier BV
Date: 11-2001
Publisher: Polish Urological Association
Date: 2018
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08032.X
Abstract: Abstract Thirty patients with symptoms and signs of stress and urge incontinence were treated with a Combined Intravaginal Sling and Tuck procedure. Primarily, only the first part of the procedure, the Sling operation was undertaken. This procedure creates an artificial pubourethral ligament which is achieved by controlled deposition of collagen around a retropubically implanted, removable, 0.5 cm wide Mersilene tape, inserted through a special tunneler. This part, stage 1 of the combined surgical procedure is mainly performed under local anaesthesia without postoperative catheterization, and early return to work. Urgency symptoms were cured simultaneously with the stress symptoms. The 50% success rate of the sling procedure was improved to 82% when the second part (stage 2) of this operation was undertaken. This procedure, the “Tuck” operation, tightens the suburethral vagina. The results of the combined procedure indicate that both an intact pubourethral ligament and tight suburethral vagina are equally important for cure as proposed in the Integral Theory of Female Urinary Incontinence.
Publisher: Elsevier BV
Date: 02-2007
Publisher: Springer Science and Business Media LLC
Date: 04-1998
DOI: 10.1007/BF01982218
Abstract: With the emergence of SARS-CoV-2 variants, vaccine breakthrough is a major public health concern. With evidence of reduced neutralizing antibody activity against Omicron variants and fading antibody level after the third-dose booster vaccine, there are suggestions of a fourth-dose booster vaccine. In this review, the benefits of a fourth-dose booster is evaluated from four perspectives, including the effectiveness of the booster dose against virus variants (Why), susceptible groups of in iduals who may benefit from additional booster dose (Who), selection of vaccine platforms to better enhance immunity (What) and appropriate intervals between the third and fourth booster dose (When). In summary, a fourth dose can temporarily boost the immune response against SARS-CoV-2 variants and can be considered for specific groups of in iduals. A heterologous vaccine strategy using mRNA vaccine in in iduals primed with inactivated vaccine may boost immunity against variants. The timing of the fourth dose should be in idualized but an interval of 4 months after the third-dose booster is appropriate. A universal fourth booster dose is not necessary.
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08029.X
Abstract: Abstract The significance of cough transmission ratios (CTR) in 6 unoperated and 15 previously operated patients is discussed. It is concluded that CTR is an index of periurethral muscle contractile activity, and vaginal wall tension, rather than urethral closure.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Polish Urological Association
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 08-1993
DOI: 10.1007/BF00372350
Publisher: Wiley
Date: 2003
DOI: 10.1002/NAU.10085
Abstract: The aim of this study was to investigate the anatomical origins and clinical significance of cough pressure transmission ratio (CTR) by using virtual-operation (VO) techniques. Thirty-four patients underwent perineal ultrasound examination, standard urethral pressure cough testing both with and without unilateral midurethral anchoring (VO), all tests being performed without urethral elevation. In eight patients where there was no change in CTR, a one-sided fold of suburethral vagina (VO) was taken (pinch test) and the CTR repeated. After midurethral anchoring, maximal urethral pressure increased from a mean of 33.25 cm H2O to a mean of 58.06 cm H2O (P < 0.0001) and restoration of anatomy was noted in all 11 patients who had obvious funneling on straining. Conversion of a 100% CTR in the proximal urethra was observed in 14 of 22 patients (P < 0.005), with no significant change noted in the distal urethra. Further conversion of CTR was noted in six of the remaining eight patients with unilateral plication of suburethral vagina (pinch test). A musculoelastic closure mechanism most likely activates urethral closure. CTR is most likely an index of changed intraurethral area, not necessarily closure, and may be a more sensitive objective test than perineal ultrasound for diagnosing urethral narrowing, especially when used with virtual-operation techniques.
Publisher: Springer Science and Business Media LLC
Date: 27-06-2018
Publisher: Springer Science and Business Media LLC
Date: 18-06-2020
Publisher: Springer Berlin Heidelberg
Date: 2007
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08027.X
Abstract: Abstract In this Theory paper, the complex interplay of the specific structures involved in female urinary continence are analyzed. In addition the effects of age, hormones, and iatrogenically induced scar tissue on these structures, are discussed specifically with regard to understanding the proper basis for treatment of urinary incontinence. According to the Theory stress and urge symptoms may both derive, for different reasons from the same anatomical defect, a lax vagina. This laxity may be caused by defects within the vaginal wall itself, or its supporting structures i.e. ligaments, muscles, and their connective tissue insertions. The vagina has a dual function. It mediates (transmits) the various muscle movements involved in bladder neck opening and closure through three separate closure mechanisms. It also has a structural function, and prevents urgency by supporting the hypothesized stretch receptors at the proximal urethra and bladder neck. Altered collagen/elastin in the vaginal connective tissue and/or its ligamentous supports may cause laxity. This dissipates the muscle contraction, causing stress incontinence, and/or activation of an inappropriate micturition reflex, (“bladder instability”) by stimulation of bladder base stretch receptors. The latter is manifested by symptoms of frequency, urgency, nocturia with or without urine loss.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1992
Publisher: Elsevier BV
Date: 09-1997
DOI: 10.1016/S0021-9290(97)00050-X
Abstract: The flow characteristic for a human female urethra is determined by direct measurement of flow rate and pressure difference data. The measurements are made on a full-scale physical model of a urethra in its open state, which was created using dimensional information taken from video cystograms. The measured data therefore include viscous dissipation effects associated with developing flow, changes in cross-sectional area and changes in flow direction. These effects are often ignored in mathematical models of this system. The data may therefore assist in the development and testing of more realistic models for urine flow. The measured characteristic is compared with a mathematical model of the flow based on a straight tube of uniform diameter carrying fully developed turbulent flow. When the diameter of the model tube is chosen to be equal to the distal diameter of the urethra, it is observed that the predicted flow characteristic provides a good first approximation to the measured characteristic, despite the substantial differences in geometry and flow regime between the mathematical model and the actual system.
Publisher: Wiley
Date: 08-03-2019
DOI: 10.1002/NAU.23954
Publisher: Springer Science and Business Media LLC
Date: 19-03-2018
Publisher: Informa UK Limited
Date: 1993
Publisher: Wiley
Date: 23-04-2018
DOI: 10.1111/BJU.14218
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.EJOGRB.2022.08.010
Abstract: To examine whether hiatal expansion and levator avulsion have a role in the causation of pelvic organ prolapse (POP). Data from studies which showed a strong association of hiatal expansion and levator avulsion were analysed for causation against an alternative view, POPcausation by ligament/connective tissue damage. Some studies potentially fitted the "Regularity Theory of Causality" i.e., an apparent cause, occurred with such regularity as to be considered a cause. However, these studies failed the logical requirement of "unconditional": all levator avulsions were to be followed directly by occurrence of POP, if the association were to be considered valid. Two studies which placed a large mesh behind the rectum and around puborectalis muscle greatly diminished levator expansion, but POP recurred in 78% of the women by 12 months. These results invalidated hypotheses of cause (levator expansion) and effect (prolapse). Levator avulsion/hiatal expansion co-occurs with POP. The cause for both is likely inability of the birth canal to plasticize" sufficiently to prevent simultaneous damage to the hiatal muscles and surrounding fascias and ligaments, which explains the co-occurrence. Greater than 90% cure of POP by site-specific repair of up to 4 pelvic ligaments supported the alternative hypothesis of simultaneous damage to pelvic ligaments to cause prolapse.
Publisher: Wiley
Date: 10-05-2022
DOI: 10.1002/NAU.24938
Abstract: Enhorning's pressure transmission theory (PTT), though mortally wounded by multiple invalidations from the 1990 Integral Theory of female urinary incontinence (IT), like Rasputin, continues to survive as a theory for continence and incontinence. To examine the questions: How has the PTT survived? What is its contribution to knowledge? Eleven different invalidations are presented based on images, pressure readings, clinical ex les, experiments by the author, and others, for ex le, flow mechanics, finite element models, and surgical operations. Each of the 11 invalidations prima facie invalidate the PTTs of enhorning and others. “How has the PTT survived?” Having provided a plausible explanation for all abdominal stress urinary incontinence operations since 100 years, PTT, unsurprisingly, like climate change today, had become an entrenched convention which abdicated the need for midurethral sling (MUS) surgeons to learn the very different functional surgical anatomy underlying the MUS. “Has the PTT progressed knowledge, or retarded it?” This lack of knowledge by the surgeons of how and why the MUS works could be held responsible for the large number of major complications reported by the TVT: including, transected urethras, obturator nerve damage, perforation of external iliac vessels, more than 20 deaths. The role of the sling is to strengthen the pubourethral neoligament to prevent the urethra opening out under stress, not to elevate it. Elevating the sling remains the major cause of the most frequent complication of the MUS today, postoperative urinary retention.
Publisher: Springer Science and Business Media LLC
Date: 27-07-2022
Publisher: Oxford University Press (OUP)
Date: 03-2015
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08031.X
Abstract: Abstract A new surgical principle which can safely result in the formation of an artificial neo‐ligament, and induce the adhesion of tissues is described. Under certain conditions, an implanted Mersilene tape may act as a template, provoking a controlled linear deposition of collagen which remained unchanged, even after removal of the tape. This was proven by retropubic implantation of Mersilene tapes in female dogs, in the position of the pubo‐urethral ligament. The procedure relies on the normally negative aspects of wound healing for its effect, such as foreign body reaction, bacterial colonization, and continued tissue breakdown and regeneration.
Publisher: Elsevier
Date: 2008
Publisher: Elsevier BV
Date: 03-2015
Publisher: Elsevier BV
Date: 04-2008
Publisher: Springer Science and Business Media LLC
Date: 23-07-2020
Publisher: Polish Urological Association
Date: 2018
Publisher: Wiley
Date: 07-07-2006
Publisher: Wiley
Date: 02-2008
Publisher: Wiley
Date: 1990
DOI: 10.1111/J.1600-0412.1990.TB08028.X
Abstract: Abstract This office test reinforces the Integral Theory of Female Urinary continence which states that there are two distinct anatomical segments of vagina which transmit the muscular contractions of the pelvic floor muscles, and in so doing, constitute the 1st and 2nd closure mechanisms. The test is based on tightening the loose vagina, hereby correcting the anatomical defects causing the stress incontinence. The Pinch Test, and with it, the Bonney Test, are analysed with reference to the 1st and 2nd closure mechanisms presented in the Theory of Female Urinary Incontinence described earlier in this issue.
Publisher: Wiley
Date: 17-07-2014
DOI: 10.1111/IJU.12575
Publisher: Wiley
Date: 17-11-2017
Abstract: Our aim was to describe a new surgical method for prophylaxis/cure of post obstetric fistula repair leakage based on restoring vaginal elasticity with Singapore skin flap. The rationale for this operation was based on the integral theory: scarring removes elasticity required for independent function of oppositely acting urethral closure forces so they become 'tethered, forcibly opening the urethra when give the signal to close'. Skin graft restores elasticity and closure. Used prophylactically with Goh type 4 fistula (n = 45), 46% were dry against an expected 19%. In patients with successful fistula closure, still with severe leakage (n = 24), 71% were dry against an expected 26%. Singapore skin flap restores elasticity and prevents and treats incontinence in patients with successful obstetric fistula repair.
Publisher: Wiley
Date: 07-12-2018
DOI: 10.1002/NAU.23840
Abstract: Part 3 briefly summarizes further development in midurethral sling (MUS) instruments and technique following the 1990 prototype operations, then critically examines the whole MUS surgical methodology, 1990 to present day. The aim is to identify positive and negative aspects of these methodologies which can be usefully applied to improve current MUS surgery. ANIMAL EXPERIMENTS: 1987-1988 proved that a collagenous neoligament could be formed by implantation of a tape. There was a wide variation in tissue reaction to implanted tapes. Inflamamatory tissue reaction was very different from bacterial infection and was safe even when a sinus is formed. MUS METHODOLOGY: The key factor in avoiding major vessel and nerve injuries is to penetrate the perianal membrane with scissors, insert the applicator. Importantly, this reveals any bleeding which could otherwise accumulate in the Space of Retzius and only be controlled by digital pressure. The balance between too tight (retention) and too loose (incontinence) is analyzed in terms of the exponential relationship between urethral diameter and urine flow why elastic tapes are more likely to cause post-operative urinary retention how to minimize retention by tightening against an indwelling No18 Foley catheter the importance of routinely repairing the distal closure mechanism with purse string suture to external ligaments, fascial layer of vagina why minislings avoid most of the serious MUS complication why a tensioned minisling allows greater precision when tightening the sling and how anchors and in idually knitted tapes give hope that tape erosions may decrease.
Publisher: Wiley
Date: 21-12-2018
DOI: 10.1002/NAU.23841
Abstract: IN: Part 1, The original 1990 science behind the MUS, the hypothesized closure mechanisms, and the prototype MUS itself were presented. The next phase of MUS development began in 1990 in collaboration with the late Ulf Ulmsten. It had two arms Further development of the prototype MUS. Further anatomical, imaging, urodynamic studies to validate the role of PUL in the closure mechanisms. A second series of prototype MUS operations performed under LA/sedation resulted in a permanently implanted polypropylene sling and the MUS as is known today. The tape was elevated until no urine leaked on coughing. This demonstrated that the artificial PUL neoligament needed to be at a specific length to work. Anatomical, EMG and video ultrasound, and X-ray studies confirmed three directional muscles contracted pubourethral (PUL) and uterosacral (USL) ligaments. The contribution of the horseshoe shaped rhabdosphincter (RS) to continence was directly tested with pressure measurements under live surgery conditions. It was concluded that the RS was responsible for pressure generation but not continence. Continence was a consequence of intraurethral resistance to flow created by the distal and proximal urethral closure mechanisms, both governed ultimately by the Law of Poiseuille. CONCLUSIONS: The key element in curing USI is creation of a competent PUL using the collagenous neoligament surgical principle described in Part 1. This creates a firm insertion point for the three directional muscle forces, restoring their contractile strength and closure.
Publisher: Elsevier BV
Date: 09-1998
DOI: 10.1016/S0301-2115(98)00092-X
Abstract: A new anatomical classification specifies anatomical defects in the anterior, middle and posterior zones of the vagina as the cause of female lower urinary tract dysfunction. An external musculoelastic mechanism stretches the vagina to open and close the outflow tract. The same pelvic floor muscles provide a peripheral control mechanism for micturition. The stretched vagina prevents the filling bladder from activating the stretch receptors in the bladder neck. Vaginal laxity may weaken transmission of muscle forces, interfering with urethral opening and closure, a mechanical process. Laxity may also destabilize the peripheral control mechanism, a neurological process, causing bladder control to swing between the open and closed modes urodynamically interpreted as bladder instability. Specific symptoms, signs, and urodynamic tests can be arranged into a pictorial algorithm. This acts as a practical guide for locating the three zones of anatomical defects. It has been possible to reinterpret almost all the definitions and descriptions of the International Continence Society (ICS) in terms of this classification, and to explain how vaginal laxity may cause premature activation of the micturition reflex (detrusor instability), stress incontinence and abnormal emptying (dribble, overflow). This convergence in anatomical and urodynamic (ICS) concepts explains many previously unexplained phenomena, and potentially opens up a new approach to management, nonsurgical strengthening of specific ligaments, or surgical reinforcement thereof with ambulatory "microinvasive" methods which do not require catheterization.
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